Malaria Consortium’s Pioneer Project, funded by the UK charity Comic Relief, is training health workers at low level health facilities in Uganda to diagnose accurately and quickly malaria in patients using Rapid Diagnostic Tests (RDTs). When this simple and relatively low cost technology is used consistently and properly it can ensure the patient receives quick and appropriate treatment.
Until recently, the practice has always been to presume that a high fever in a malaria endemic area was most likely to be malaria and therefore should be treated accordingly; only if this did not work would other treatments be considered. This approach not only reflected the high prevalence of malaria but also the lack of facilities to make a confirmed diagnosis. Just 35 percent of suspected cases in endemic African countries were confirmed by parasitological test in 2009.
In Uganda, where the Pioneer Project is tackling this issue head on, the management of malaria cases in Uganda has been characterised by gross over-diagnosis and over-treatment. Until recently, in the absence of adequate infrastructure or skilled personnel to conduct microscopy at low-level health facilities, all fever patients without evidence of other disease were typically treated for malaria.
Now the World Health Organisation has issued new guidelines on the need for confirmatory diagnosis prior to treatment and these are being implemented by ministries of health, including in Uganda. But for this to become truly effective, these ministries need to commit financially to ensuring a consistent supply of RDTs and training in their use.
National governments are beginning to recognise that the use of RDTs may ultimately be a more cost-effective alternative to presumptive treatment with expensive anti-malaria drugs and is the key to the management of malaria and ultimately its elimination. Widening access to confirmed diagnosis for malaria via these lower level health facilities, where quality microscopy is not available, can also provide a more accurate picture of the true burden of malaria in the country, allowing governments to be more efficient when allocating resources.
But it is no easy task to change decades of practice and behaviour. Health workers need to learn to change how they have always worked; caregivers expect to receive the drugs they have always received and don’t always take kindly to being told or given something different. Without reform of these practices, the expected impact of RDTs will not be realised.
Watch our new film on the impact RDTs are having in Hoima, Uganda under the Pioneer Project.
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